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Recommendations for Plyometric Training after ACL Reconstruction

by | Jun 26, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction/Background

The article introduces a four-stage plyometric training program as part of criterion-based rehabilitation for athletes post-ACLR. It emphasizes the importance of aligning plyometric tasks with the patient’s functional recovery status, considering factors like task intensity, momentum, ground contact time, and surface. The goal is to enhance neuromuscular function, movement quality, and reduce injury risk, facilitating a timely return to sport.

Post-ACLR, many athletes struggle to return to their previous performance levels and are at a heightened risk of re-injury. Deficits in neuromuscular performance, such as reduced strength and movement asymmetries, are common. Plyometric training involves rapid muscle lengthening followed by shortening, is highlighted as an effective method to improve explosive performance and neuromuscular control, surpassing traditional resistance training in some aspects.

This article aims to provide clinicians with a guideline on designing and implementing plyometric programs tailored to the ACLR patient’s recovery stage.

Methods

The program is divided into four stages, each aligned with specific phases of rehabilitation:

  • Stage 1 (Mid-Stage Rehabilitation): Focuses on foundational movements with low intensity, emphasizing control and technique.
  • Stage 2 (Late-Stage Rehabilitation): Introduces moderate-intensity exercises, incorporating more dynamic movements while maintain control.
  • Stage 3 (Late-Stage Rehabilitation): Advances to higher-intensity plyometrics, emphasizing power and agility in preparation for sport-specific activities.
  • Stage 4 (Return-to-Sport Training): Involves high-intensity, sport-specific plyometric exercises to simulate real-game scenarios, ensuring readiness for return to sport.

Each stage considers task intensity, movement complexity, and the athlete’s ability to perform exercises with proper technique. Progression through stages is based on meeting specific criteria, ensuring safety and effectiveness.

The article emphasizes the importance of continuous monitoring throughout the rehabilitation process. Clinicians should assess movement quality, control in both frontal and sagittal planes, and the athlete’s response to increasing exercise intensity. If an athlete cannot perform tasks with minimum competency, exercises should be simplified. Daily monitoring of pain, swelling, and soreness is recommended to guide progression and prevent setbacks.

Conclusion

Plyometric training is a crucial component of functional recovery post-ACLR. A structured, criterion-based approach ensures that exercises are matched to the athlete’s recovery status, promoting neuromuscular reconditioning and reducing the risk of re-injury. Clinicians are encouraged to integrate this four-stage program into rehabilitation protocols to optimize outcomes for ACLR patients.

References

Buckthorpe, M., and Della Villa, F. (2021). Recommendations for Plyometric Training after ACL reconstruction: A Clinical Commentary. International Journal of Sports Physical Therapy, 16(3), 879-895. https://doi.org/10.26603/001c.23549

Using Graded Motor Imagery in the Management of Chronic Low Back Pain

by | Jun 19, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction/Background

Chronic low back pain is complex and often not explained by a structural pathology alone. Modern pain neuroscience suggest that persistent pain may be due to maladaptive neuroplastic changes. In this article, the authors introduce Graded Motor Imagery (GMI). GMI is a three-stage neurorehabilitation approach (left/right discrimination, explicit motor imagery, mirror therapy) designed to treat chronic pain by altering the central nervous system processing.

Methods

A 67-year-old female with a 30 year history of chronic LBP participated in the study. Her pain significantly impacted her quality of life and daily function. Prior treatments- medications, injections, physical therapy, provided limited relief. The patient was introduced to GMI as an alternative strategy.

Initial assessment revealed central sensitization, pain-related fear, and body perception disturbances. Outcomes included the Oswestry Disability Index (ODI), Pain Catastrophizing Scale (PCS), and the Fremantle Back Awareness Questionnaire (FreBAQ). The results showed high disability and distorted body perception.

GMI was introduced in three graded stages over several weeks:

  1. Left/Right Discrimination: The patient identified images of backs as left or right to stimulate sensorimotor processing.
  2. Explicit Motor Imagery: She visualized moving her back without actually moving.
  3. Mirror Therapy: Movements were performed with a mirror to stimulate normal movement and reduce fear and pain.

The intervention was tailored to her tolerance, emphasizing progression without exacerbating symptoms.

Results

After the GMI program, the patient reported:

  • Reduced pain and disability (improved ODI scores)
  • Improved body awareness (better FreBAQ scores)
  • Lower fear and catastrophizing thought (reduced PCS)

She was able to return to activities she had previously avoided due to pain.

Discussion

The report highlights GMI’s potential to target central nervous system changes underlying chronic pain. It emphasizes the importance of treating not just tissue damage but also the brain’s perception of the body. The results support the integration of GMI into pain rehabilitation, particularly for patients with evidence of central sensitization and distorted body image.

Conclusion

GMI was an effective, low-cost, and non-invasive that helped reduce pain and disability in a patient with longstanding chronic LBP. The case supports its use as part of a multidisciplinary pain management approach.

References

Iglar, D., Dritsas, J., and Cortese, F. (2021). Monkey see, monkey do: Using graded motor imagery in the management of chronic low back pain- A case report. Journal of Orthopaedic & Sports Physical Therapy, 51(1), 41-41.. https://doi.org/10.2519/jospt.2021.9966

Suture Tape Augmented Brostrom Procedure and Early Accelerated Rehabilitation: A retrospective comparison of augmented and nonaugmented repair.

by | Jun 13, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction/Background

Chronic lateral ankle instability is a common issue that can result from repeated ankle sprains, leading to ligamentous laxity and functional impairment. The traditional Broström procedure has been widely used to restore ankle stability by directly repairing the lateral ankle ligaments. However, concerns remain regarding early failure due to inadequate ligament healing and the need for prolonged immobilization during rehabilitation.

Methods

A retrospective review of 93 patients who underwent the suture tape-augmented Broström procedure was conducted. The inclusion criteria were patients with persistent ankle instability despite conservation management. The exclusion criteria included prior ankle surgery, severe osteoarthritis, and neurological deficits affecting ankle stability.

The surgical technique involved performing a standard Broström repair, followed by reinforcing the lateral ankle ligament complex with a non-absorbable suture tape anchored into fibula and talus. This augmentation was designed to provide additional mechanical support while still permitting natural joint motion.

Postoperatively, patients followed an accelerated rehabilitation protocol that emphasized early weight-bearing and functional exercises. Outcomes were assessed based on complication rates, re-injury occurrences, and the timeline for returning to unrestricted activity.

Results

None of the patients experienced failure of the repair or recurrent instability during the follow-up period. Compared to traditional protocols, the suture tape augmentation allowed for an accelerated return to functional activity. Military personnel resumed agility drills approximately four weeks earlier than conventional rehabilitation protocols would typically permit. There were no significant postoperative complications such as infections, deep vein thrombosis, or hardware-related irritation. Patients reported minimal pain and swelling, and none required surgical revision.

Discussion

The study’s finding suggests that suture tape augmentation in the Broström procedure provides significant advantages over traditional repair methods. The reinforcement from the suture tape allows for immediate post-surgical stability, reducing the risk of failure due to early ligament stretching. This added support enables earlier weight-bearing and a more aggressive rehabilitation approach, which is particularly beneficial for high-performance populations such as athletes and military personnel.

Additionally, the study highlights that while some surgeons may hesitate to introduce synthetic augmentation into soft tissue repairs due to concerns about long-term biocompatibility, the suture tape used in this procedure did not result in adverse reactions. The ability to maintain the native ligament’s natural function while providing supplemental stability makes this approach a promising alternative to conventional Broström repair.

Potential limitations of the study include its retrospective nature and the lack of long-term follow-up data. Future research should focus on randomized controlled trials to compare suture tape-augmented repairs directly with traditional Broström procedures over extended periods.

Conclusion

The suture tape-augmented Broström procedure is a safe and effective technique for treating chronic lateral ankle instability. It provides immediate mechanical stability, reduces the risk of failure, and allows for early functional rehabilitation without increasing the likelihood of complications. Given these benefits, the procedure may be particularly well-suited for individuals who require a rapid return to activity, such as military personnel and athletes. This study supports wider adoption of this technique in clinical practice and suggests that it could improve surgical outcomes for patients with chronic ankle instability.

References

Martin, K. D., Old, S. B., Dauer, E. A., Hutton, J. R., & Bahr, R. A. (2020). Suture tape-augmented Broström procedure and early accelerated rehabilitation: A retrospective comparison of augmented and nonaugmented repair. Foot & Ankle International, 41(12), 1523-1532. https://doi.org/10.1177/1071100720959015

A systematic review of running-related musculoskeletal injuries in Runners

by | Jun 5, 2025 | Health Tips

Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction/Background

This systemic review examines the incidence and prevalence of running related musculoskeletal injuries (RRMIs). The knee, ankle, and lower leg are thr most commonly injured sites, with Achilles tendinopathy and patellofemoral pain syndrome being prevalent. It was found that there are no significant differences between ultramarathoners and non-ultramarathoners. Running has numerous health benefits but also a high rate of overuse injuries. Updated epidemiological datais needed for better prevention and rehabilitation.

Methods

A systematic search was conducted in SPORTDiscus, PubMed, and Medline databases up to
June 2020, with date restrictions. Prospective studies were included for incidence data, while
retrospective or cross-sectional studies were used for prevalence data. The analysis also
separately considered ultramarathon runner to identify any differences in injury patterns
 

Results

Overall injury rates:
The mean injury incidence was 40.2%, and the mean prevalence was 44.6%.
 
Anatomical locations:
Incidence: Knee (27.0%, ankle (25%), lower leg (23%). Prevalence:
knee (28%), lower leg (16%), and foot/toes (14%).
 
Specific pathologies:
Incidence: Achilles tendinopathy (10.3%, medial tibial stress syndrome
(6.3%), plantar fasciitis (6.1%), ankle sprains (5.8%). Prevalence: Patellofemoral pain syndrome
(16.7%), medial tibial stress syndrome (9.1%), plantar fasciitis (7.9%), iliotibial band syndrome
(7.9%), Achilles tendinopathy (6.6%)
 
Ultramarathoners:
Similar injury distribution, with anterior compartment tendinopathy (19.4%)

being notable, patellofemoral pain syndrome (15.8%), and Achilles tendinopathy (13.7%).

No significant difference in injury incidence proportions by anatomical location were found
between ultramarathoners and non-ultramarathoners.
 

Discussion

Knee and ankle injuries dominate, with Achilles tendinopathy and patellofemoral pain syndrome being most prevalent.. Most likely due to biomedical demands and repetitive stress. It also notes limitations in included studies due to inconsistent injury definitions and varying study designs which may affect the interpretation of epidemiological data.
 
Findings suggest need for future research and consistent injury definitions.
 
 

References

Kakouris, N., Yener, N., & Fong, D. T.-P. (2021). A systematic review of running-related
musculoskeletal injuries in Runners. Journal of Sports Science & Medicine
https://doi.org/10.52082/jssm.2021.672

Rehab in Patients with Cerebellar Ataxias

by | May 29, 2025 | Health Tips

 Reviewed by Tyler Tice, PT, DPT, OCS, ATC

Introduction

Commonly, ataxias are caused by cerebellar disorders of peripheral nerves. People with ataxias are likely to have most difficulty with gait, balance, speech, swallowing, and vision leading to a reduced quality of life. To date, there is no cure for the progressive disease, but some interventions may be helpful in managing the symptoms. This review aims to compile available data on rehabilitation interventions for managing cerebellar ataxia.

Methods

A total of 58 studies collected were published in Portuguese or English between 1990-2020. The review also included articles on the topics of new and emerging interventions.

Results by Category

Physical Therapy

Physical therapy is recommended for all stages of the disease. Coordination training improves motor performance and reduces ataxia symptoms. There is weak evidence for using virtual reality, biofeedback, and bodyweight support treadmill exercises for postural training, however high-intensity motor coordination training proved beneficial for those with degenerative ataxia for stability and motor coordination. Many studies at various levels of evidence conclude that rehab improves mobility, function, ataxia, and balance in adults and children, however, studies lack long-term follow-up and specific training strategies.

Outcome Measures and Clinical Scales

Scale for the Assessment and Rating of Ataxia is commonly used to quantify severity of ataxia with good construct validity. The Neurological Examination Score for Spinocerebellar Ataxias is also commonly used for measuring ataxia severity with good interrater reliability and consistency. The Berg Balance Scale and Timed Up and Go were determined to be the best outcome measures for the population.

Exergames and New Technologies

Incorporating virtual reality into therapy (exergames) can add a motivational aspect to rehab and target coordination, balance, and weight transfer. Some studies found that games such as the Wii can not only improve daily training, but also if used regularly can improve postural sway, balance, gait, and fall frequency.

Speech, Voice, Swallowing Therapy

Early detection and intervention for swallowing and speech impairments for degenerative ataxias is important due to the ultimate progression of the disease. Early intervention can improve swallowing and speech can enhance quality of life.

Occupational Therapy

OT can improve balance, and coordination of patients with degenerative ataxias, however, when combined OT and PT is more effective for long-term benefit. Though it is known that OT should be tailored to patients’ specific needs, specific aspects of treatment and interventions should continue to be studied.

Conclusion

Although there is no cure for cerebellar ataxias, various studies have proven that physical therapy, occupational therapy, speech therapy is essential for patient care and can aid with management of the disease. Some studies suggest they are best used in combination and when implemented early.

Reference

Chien, H.F., Zonta, M.B., Chen, J., Diaferia, G., Viana, C.F., Teive, H.A.G., Pedroso, J.L., &Barsottini, O.G.P. (2022). Rehabilitation in Patients with Cerebellar Ataxias. SciELO Brazil, 80(3), 306-315. https://doi.org/10.1590/0004-282X-ANP-2021-0065